Wednesday, 28 December 2011

Action against Medical Accidents

According to several comprehensive studies of the issue, medical errors are far from rare. That is alarming.

But diagnostic errors - a subset of the overall problem - haven't received nearly as much attention as other medical errors.

"Diagnostic error is barely on anybody's radar screen," according to Dr. Mark Graber, 62, a nephrologist in Long Island, N.Y., and an expert on diagnostic errors. That is a cause for grave concern, grave being the operative word.

Misdiagnosis may result in any one of many outcomes. Misdiagnosing death that results in being placed on the Liverpool Care Pathway will have only one outcome. Clearly, LCP is a one-way ticket on the NHS (National-socialist Health Service) into the next world. Our concern is well-founded!

Action against MedicalAccidents(AvMA – the charity for patient safety & justice) has campaigned for the introduction of a legal duty of candour in healthcare in the UK – the so-called 'Robbie's Law'.

There are laws set in place to protect consumers. Transparency and the free flow of truthful information are key features of such legislation. Say that again: Transparency and the free flow of truthful information are key features of such legislation!

But what of a human life, our very selves, our human flesh and blood, the only thing any of us, each of us, will truly possess throughout our lives, in luxury or in penury? Can this be said enough, that it should have to be said at all, that this is something utterly beyond value, invaluable. To take any stance other than unconditional support for such legislation diminishes human life such that it becomes quite, quite worthless.

The Health Secretary, Mr. Andrew Lansley, has declared himself against this measure. Shame on you Mr. Lansley! Clearly, the opinion of the medical lobby carries great weight at Westminster. Their reluctance to throw out the bad apples is well documented.

The truth is more ugly and more messy than could it ever have been conceived to be.

The fact that the culprits are not served their just deserts bears out what we were told.

The truth is that what goes on – and what has gone on for years – continues to go on.

Action against Medical Accidents (AvMA) is the independent charity which promotes better patient safety and justice for people who have been affected by a medical accident. A 'medical accident' is where avoidable harm has been caused as a result of treatment or failure to treat appropriately. AvMA believes that whatever the cause of a medical accident, the people affected deserve explanations, support, and where appropriate, compensation. Furthermore, we all deserve to know that the necessary steps will be taken to prevent similar accidents being repeated.

But what of diagnostic errors, a subset of the overall problem, and which haven't received nearly as much attention as other medical errors? What is AvMA’s stance on those?

What is AvMA’s stance on the Liverpool Care Pathway? This is problematic. A diagnosis of impending death which then results in death can hardly be said to have been in error or be considered to be a ‘misdiagnosis’. The LCP protocols, however, applied judiciously and to the letter, will guarantee only this one outcome.

Dr. Patrick Pullicino echoes the views of a not insignificant body of medical opinion when he states:

“It is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.”

And what is AvMA's position in that regard?

The Liverpool Care Pathway is a legal document established as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing care’.

CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.

To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.

Clearly a misdiagnosis is a medical error and, therefore, is called to the remit of AvMA. Clearly, this is a connived medical error through the involvement and policy of the DOH. Can Government Ministers, then, be said to be complicit in it?

This comment from the LCP Petition site is reported previously. It bears repetition. 23:40, Dec 02, Dr. Patrick Pullicino, United KingdomIt is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.

Wednesday, 21 December 2011

A response taken from The Telegraph letters column:One-way path to death

SIR – My family had some experience of the Liverpool Care Pathway (report December 1) last year.

My mother, aged 99 and living in a nursing home, was taken as an emergency to a hospital A & E department with acute respiratory distress. My brother and I arrived soon after. The doctor told us there was no help for her and that she would probably only live for about two hours.

Obviously unwell, but responsive, she was transferred to a stark room and her saline drip taken down. A nurse wanted to remove her oxygen mask, but she insisted on keeping it, as it helped her breathing.

Another nurse was about to give her an injection of morphine, but I challenged this as my mother was not complaining of pain. The nurse said it was normal protocol.

In answer to our questions, we were told that Mother had been placed on the “care pathway of the dying” and that she would not be given any food or water but would have regular sedation.

We asked if she could be transferred to a private ward to be more comfortable in her final hours. This was arranged promptly. Her physician confirmed she was indeed terminally ill and no medication would be appropriate, only care. To everyone’s surprise, she began to improve and after a week could take sips of water and food.

Mother lived for a year, visited daily by family and friends. The highlight of her “extra” year was her 100th birthday, when she entertained 40 people to a tea party.

She would not have lived that extra year, had she been denied water and sedated in hospital last year.

Sunday, 18 December 2011

This is taken from Janette Miller’s Blog. Liverpool Care Pathway care is not palliative care; upon reading the description of the events which befell this poor lady’s husband, quite clearly, it is not even care...

Death by Liverpool Care Pathway

Loved ones not always told their relative is on controversial 'death pathway'

NHS DOCTORS ARE FAILING TO INFORM UP TO HALF OF FAMILIES THAT THEIR LOVED ONES HAVE BEEN PUT ON A SCHEME TO HELP END THEIR LIVES, THE ROYAL COLLEGE OF PHYSICIANS HAS FOUND. TELEGRAPH.

I watched my husband die in a hospice which used the Liverpool Care Pathway. It was revolting experience and I was truly horrified and shocked. My husband had chosen to die but I am not sure he realized just how horrible his death would be for him and me.

My husband Miles was 72 and had a very rare blood disease MDS. He struggled on for 9 months and then decided that he had had enough. He had the choice of staying in hospital or going to the hospice. Miles made the wrong choice for even though he was dying Miles needed to be treated.

Miles did not wish to bleed to death and he needed platelets but these were denied him in the hospice although he had been promised them in the hospital. Fully conscious Miles was slowly bleeding to death in front of my eyes. I had a blazing row with the staff who told me they did not treat and even if it were allowed they had no free staff to collect the platelets from the blood bank. Eventually I walked the 15 minutes to the hospital and got the platelets myself. What they were allowing to happen was inhumane.

They stopped the anti biotics and his eye started to fall out! Again I made them put him back on anti biotics and again I had a row to get them to do this.

Immediately he got there he was put on drugs and started twitching. I know now that this is an adverse reaction to these drugs and he soon lost consciousness. I also caught one of the staff handling him very roughly which I found offensive. I was too stressed to do anything about this.

Meals and drink are placed on a tray beside the bed but of course the patient is so ill he or she cannot eat it. They don't starve you as they present the meals but no one feeds you. The food is there, the water is there - Oh it is so clever.

I fed him with Complan but eventually the drugs took hold. He obviously wanted a drink. Miles was literally dying of thirst. If I swabbed his mouth with water his tongue sort out the moisture. He dried out in front of me. I felt this lack of water treatment was worthy of Belsen. This I found the most distressing of all.

It took seven days to kill him for that is the only way I can describe the Liverpool Care Pathway. They could kill anyone that way. I would not treat my cat in such a fashion. As it happened my cat had to be put down at the same time and I think the cat had the best of it! My cat died with dignity at the vets and that is more than can be said for my husband in the hospice.

It was his choice and it is apparently legal but I am not going anywhere near a hospice. I do not want to die of thirst. I think if the public were aware of the cruelty that the Liverpool Care Pathway entails it would be stopped instantly.

I am disgusted that this cruel way to die is not even discussed with the patients' families. The sooner we are allowed to die with dignity like my cat the better.

THE callous treatment of the elderly in NHS hospitals has been exposed by a doctor who claims patients are denied life-saving treatment, are grossly neglected and are given drugs which hasten death.

Rita Pal, 28, a junior doctor, was so disturbed by her experiences that she is leaving the profession. This week she will submit a dossier to the General Medical Council (GMC) detailing the cases of abuse that she saw.

"I have witnessed doctors who want to keep beds clear by withdrawing treatment or actively assisting in death to the point where it becomes involuntary euthanasia," she said. She wants the government to set up an independent inquiry. Among the cases which Pal witnessed were:

· A doctor who ordered the withdrawal of life-saving medication of a dying patient after stating that the hospital needed beds.

· A diabetic patient in her nineties who was deprived of basic medical attention after a nurse commented, "She will die anyway."

· Critically ill patients whose lives were cut short after being given "unnecessary" doses of diamorphine, which is commonly known as heroin.

· A doctor who, when told about a patient dying from a liver complaint, said, "Well, he is over 60", and made no effort to administer medical attention.

Pal, from Sutton Coldfield, West Midlands, trained at University College London. She joined North Staffordshire hospital in 1998 and worked on two general medical wards - each with about 40 patients. In her first month, a senior doctor ordered the medication to be withdrawn from an 89-year-old stroke victim who was critically ill and could not speak because he had a plastic tube down his throat.

"This man was actually conscious and could hear us," said Pal. "The doctor said, 'We need the bed - stop all his medication'. He obviously didn't think he was going to live. I thought: we are killing someone because we want the beds.

"They stopped the medication and at about 9.30pm he started getting short of breath. I held his hand and said, 'You will be all right'. I was sickened by the whole episode."

Pal disobeyed the doctor and gave the patient drugs to help him breathe. He was transferred to another unit, but later died. The doctor, whose name is known to The Sunday Times, declined to comment last night.

Last week one of the man's relatives said: "I think the NHS is atrocious. I don't think they care about old people."

Another elderly woman, who was diabetic, was also allegedly neglected after being admitted in November 1998. She was in danger of dying if her blood sugar went too high, but the nurses failed to monitor her properly. "She was incontinent and they wouldn't even clean her up properly," she said. "I must have asked the nurses at least 10 times to monitor the blood sugar. One nurse said, 'She will die anyway'."

In January 1999, Pal took up a new post at Selly Oak hospital. Although she said ward conditions were better, she was disturbed at the liberal use of diamorphine, which eases pain and is used to treat heart conditions but can also hasten death.

In one case she was so convinced a dose of diamorphine she had been ordered to give would be fatal that she injected it into the patient's mattress.

When another doctor saw that the patient was alive the next day, he said: "Oh, she is still alive - didn't you start her on diamorphine?" The patient, suffering from pneumonia, later recovered and left hospital.

"The doctor ordered that she be given the drug without examining her and I felt his decision was based on her age," said Pal. "I think diamorphine would have killed her because it would have reduced her respiratory rate. The doctor thought she was going to die anyway, but days later I saw her sitting up and putting on her lipstick."

Pal also encountered alleged abuse of diamorphine at North Staffordshire. On one occasion a female patient died after being given what Pal considered an unnecessary dose. "She was dying, but I think this was speeded up," said Pal. "This was involuntary euthanasia."

Her disillusionment with the NHS grew after she failed to save the life of a patient admitted to Worcester Royal Infirmary with internal bleeding after being discharged prematurely. She feared the patient was bleeding to death as he lay on a trolley in accident and emergency, but none of the staff available had the necessary expertise to treat him. The patient started to vomit blood, but there was no intensive care bed available.

When she contacted a senior member of the medical team, the doctor said: "Well, he is over 60." The patient was subsequently given the necessary treatment but died after being transferred to another hospital.

Pal is now studying to be a barrister. "I have lost faith in medicine," she said. "There is a code of silence and it's the hardest thing to stand up and say something."

One doctor who worked with Pal said she had raised legitimate concerns about the use of diamorphine. "It's the question of where you draw the line between relieving pain and terminating life," he said.

Dr Michael Irwin, vice-chairman of the Voluntary Euthanasia Society, said: "My main concern is that diamorphine is being used without consulting patients or talking to relatives.

"That is involuntary euthanasia and although we know it happens, we don't know the extent - there are probably thousands of cases each year."

Dr Nigel Sykes, a consultant in palliative medicine at St Christopher's hospice in London, said: "I have seen patients overdosed with diamorphine so it certainly happens, but I don't believe it is done wilfully."

The cruelty and inhumanity of treatment meted out to some elderly patients in the NHS was exposed two weeks ago by The Sunday Times. An undercover investigation by a reporter in two hospitals revealed that patients were not receiving proper medical attention, were left in soiled clothes for long periods and were routinely neglected. The article prompted a deluge of letters from readers.

Pal's most serious allegations are made in the context, she said, of a health service which is in "disarray" and routinely failing its patients.

Pal, who was regularly working 16-hour days, admits her own supervision was so inadequate that in November 1998 she nearly killed one patient who was suffering from a serious gall bladder infection.

After failing to contact more senior doctors, Pal gave the woman a drip because of her falling blood pressure. The young doctor was, however, so inexperienced that she gave the patient too much fluid too quickly which "tipped" her into heart failure. The woman recovered, but died days later.

Last week North Staffordshire hospital said Pal's allegations will be "taken seriously and fully investigated".

Andrew Reid, medical director of University Hospital Birmingham NHS Trust, which includes Selly Oak hospital, also said Pal's allegations would be investigated if she provided further details. A spokesman for Worcester Royal Infirmary said the liver patient Pal saw had been discharged "inappropriately" but, when readmitted, received the specialist treatment he required.

an organisation dedicated to the prevention of neglect and incompetence in our National Health Service, and to the elimination of the secrecy which allows these problems to flourish. "Sunlight is the best disinfectant"¹

This is from the Patient Protect website. The subject matter is hauntingly close to and parallels and mirrors the content produced in these pages:

Most patients enter hospital with the belief that they will be treated by competent staff, and that they will receive whatever treatment they need in order to achieve a successful outcome. The Patients’ Charter, recently abolished by this Government, actually stated that these beliefs amounted to a right, presumably protected by the Government.

The reality, however, is there is not enough money in the pot to allow everyone to get the treatment they need, and rationing is here to stay. Although most hospital staff are caring decent people, many can and do work beyond their level of competence, free from accountability, with their mistakes and identities hidden from the public.

Most rationing in our hospitals also goes on in secret. The elderly are usually the targets, although anyone who can be labelled as an unproductive member of society is at risk. As well as working to stop this discrimination, Patient Protect aims to make patients aware of what is happening. After all, secret rationing can only survive if it is kept secret.

Although the initial focus of this site was on NHS Hospitals, it is now clear that the problems we see are common to all areas of the health care system, both NHS and Private. For more details of the state of the private sector, check the article "Private Hospitals can damage your health". At present it seems that hospitalisation is safest as a private patient in an NHS hospital.

How rationing actually works.

1)Why the young, the elderly and the disabled are targeted for rationing.

The first thing to understand is that the new "NHS Trust Hospital" is really nothing more than a commercial business, run by business managers whose chief responsibility is to work within the budget set by the government.

The managers know that there is not enough money to allow all the patients to get the treatment they need (and which they were promised under the Patients' Charter) but they also know that to fail in their duty to provide proper treatment can lead to huge awards of damages in the courts.

The solution to this problem is to exploit the method the courts use to decide what the level of damages should be. If the hospital negligently kills a 30 year old family breadwinner, they can end up compensating the family for the loss of future earnings - this can be millions of pounds. Similarly, killing a mum with three young kids can lead to big payments for hiring cook, nanny, housekeeper plus compensation for any income she may have had.

Negligently killing a young child, an elderly person or someone disabled, however, is virtually free of these risks, for the simple reason that there is hardly ever any dependency requiring compensation. Of course, families can and do complain bitterly, but 'toughing out' a complaint is cheap, as is the eventual issuing of an apology.

Compared with wards for younger adult patients, wards for the elderly are affected in three ways by rationing:

i) reduction in quality and quantity of staff

ii) reduction in quality and quantity of equipment

iii) tighter controls on what treatments can actually be carried out, regardless of how necessary they are.

A phenomenon known as "supply driven demand" then operates as staff learn not to ask for things they know they will not get. Why do staff, whose primary duty is to put the interests of the patient first, accept these restrictions?

First, many of the staff who find these restrictions intolerable either avoid working on the wards for the elderly or quit altogether.

Second, of the staff who remain, some do care , but feel powerless to do anything. All nurses know that if they complain, or stand up for the patients, they are going to face hardship and sooner or later get fired; all nurses know the story of nurse Pink. Doctors also know that 'troublemakers' and 'whistleblowers' do not get good references or promotions and may, like Dr Bolsin have to leave the country to find work. A recent survey in The British Medical Journal found that a quarter of staff in an (unnamed) NHS Trust reported that they had been subjected to bullying in the previous year.

Third, some staff simply do not appear to care. Staff guilty of awful cruelty and neglect can avoid a guilty conscience by using 'techniques of neutralisation'. Examples of these techniques in use include:

"The funding cuts aren't my fault" (denial of responsibility)

"She was going to die anyway" (denial of victim)

"The resources are better used on someone else" (appeal to higher loyalty)

Fourth, some staff have ended up callous and heartless. Although they would not be tolerated on other wards, management allow them to remain on the elderly wards, presumably because they can be relied on never to stand up for the elderly patients.

3) How rationing works at the level of the patient.

It can be summed up as 'Lambs to the Slaughter'. Most patients and relatives will not realise (and will certainly not be told) that they are not getting a pressure relief mattress, even after they have developed bed sores; they naturally believe that the 'Nil by Mouth' sign over the bed is there for the patient's benefit (in some cases, no staff will admit to putting the sign there in the first place); 'Do not resuscitate' orders written in the notes frequently come to light only after the patient has died. Even if the relatives or patients do realise what is happening, it is often too late to reverse the damage. Patients, their relatives and their friends usually lack the experience and assertiveness to get past a skilful gatekeeper.

Secret rationing of treatment is bad enough, but there is worse. Although some patients may die promptly following withdrawal of treatment, others are stronger and threaten to linger on. These 'bed-blockers' often receive a helping hand with, for example, overdoses of diamorphine or diuretics. Diamorphine (heroin) is fast and effective, especially in someone unused to the drug and already weak. First it induces coma, followed by respiratory depression, and death. For the hospital, this has the advantage of having the patient slip away quickly and quietly without any fuss. Diuretics cause dehydration, and although the result is ultimately the same as with diamorphine the patient may survive, conscious, for up to a week even with the imposition of a 'Nil by mouth' regimen. Relatives who do not know the signs of dehydration may be tricked into believing that the rapid deterioration is due simply to the underlying illness.

Wednesday, 7 December 2011

In recent days, Rebecca Smith, Telegraph Medical Editor, has produced a confusion of reporting and confusing articles.

Tens of thousands of patients with terminal illnesses are being placed on a “death pathway”, almost double the number just two years ago, a study published today shows.

Health service guidance states that doctors should discuss with relations whether or not their loved one is placed on the scheme which allows medical staff to withdraw fluid and drugs in a patient’s final days. In many cases this is not happening, an audit has found. As many as 2,500 families were not told that their loved ones had been put on the so-called Liverpool Care Pathway, the study disclosed.

These articles, a hotchpotch of conflictingly sourced comment, culminated in a report from NICE that, actually, patients are under-treated.

These two quoted statements from the same article above suggest that the problem with the LCP, or the "death pathway" as Rebecca Smith refers to it, is in its implementation and not in its substance -

Kevin Fitzpatrick, spokesman for the campaign group Not Dead Yet, said: “It is very worrying that in any situation less than 100 per cent of families are being consulted before patients are being put on the Liverpool Care Pathway. It is a shock for families to find that out.

Sarah Wootton, chief executive of the campaign group Dignity in Dying, said: “The NHS is clearly moving in the right direction. However, the report highlights there is a need for further training and education on end-of-life communication. As a society we need to appreciate that dying is not a failure of medical care and treatment, but dying badly is.”

Dr. Kevin Fitzpatrick supports the right to live; Sarah Wootton supports the right to die. Dignity in Dying is the pro-euthanasia lobby group. LCP has been equated with back-door euthanasia. If Sarah Wootton sees implementation of the flawed LCP as moving in the right direction, that is worrying, indeed.

This comment is from the LCP Petition site:23:40, Dec 02, Dr. Patrick Pullicino, United KingdomIt is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.

Tuesday, 6 December 2011

The Department of Health committed to investing 286 million pounds over the two years to 2011 to support implementation of this End of Life Care Strategy. That is 286 million pounds spent to assist people on their path to the next world while denying them the necessary funding to remain alive and well in this. That is because it is the cheaper option.

Doctors in our local surgeries, hospitals and health care centres are providing us with treatments based on our illness, our age, our families. A Daily Mail article explains how doctors tend to late-diagnose older patients or provide them with less beneficial treatments. The elderly are routinely denied surgery or drugs.

Here are further comments left by petitioners to register their opposition to the Liverpool Care Pathway -

23:40, Dec 02, Dr. Patrick Pullicino, United KingdomIt is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.

18:15, Dec 02, Mr. John Trask, United KingdomParticularly when the patient is a wife, a mother, a business partner and only 49years old!

15:04, Nov 25, Ms. Christine Griffiths, United KingdomCan we trust that the LCP is only being used to ease the process of dying and not to hasten death itself.There is always talk of 'evidence based medicine.' I insist on the right to 'evidence based trust.'

Please do continue to register your support for these petitions.

Remember, complacency always permits the unthinkable to become thinkable and the unacceptable to become possible.

About Me

I am distraught and I despair that these events have befallen this family. The picture is of me and my lovely mum, murdered on the NHS (National-socialist Health Service). Murdered. Is that too strong a word? Her life was taken without her permission. By omission and by commission, actions taken and not taken conspired to end her life. She was kept in ignorance of what was proceeding before her very eyes, as were we. Was she, then, not murdered?